ADA、TB-DNA、TB-Ab在血行播散型肺结核合并结核性脑膜炎患者中的诊断应用  

Application of ADA,TB-DNA and TB-Ab in the Diagnosis of Hematogenous Pulmonary Tuberculosis with Tuberculous Meningitis

作　　者：赵娟娟 麦迪宇 ZHAO Juanjuan;MAI Diyu(Nanning Fourth People’s Hospital,Nanning 530023,China)

机构地区：[1]南宁市第四人民医院,广西南宁530023

出　　处：《中外医学研究》2022年第3期70-73,共4页CHINESE AND FOREIGN MEDICAL RESEARCH

摘　　要：目的:探讨腺苷脱氢酶(ADA)、结核分枝杆菌-DNA(TB-DNA)、结核抗体(TB-Ab)对血行播散型肺结核合并结核性脑膜炎(TBM)的诊断价值。方法:选取2017年1月-2019年12月在南宁市第四人民医院治疗的80例血行播散型肺结核患者,均疑似合并结核性脑膜炎。所有患者行腰椎穿刺留取脑脊液,进行ADA、TB-DNA、TB-Ab检测。以临床诊断结果为金标准,评估ADA、TB-DNA、TB-Ab及联合检测的诊断效能,并进行一致性分析。结果:在单项检测中,TB-DNA诊断的特异度为95.8%,高于ADA的62.5%和TB-Ab的45.8%,差异有统计学意义(P<0.05),但ADA、TB-Ab特异度比较,差异无统计学意义(P>0.05)。串联检测的特异度为100%,高于ADA和TB-Ab单项检测,差异均有统计学意义(P<0.05)。并联检测的敏感度为91.2%,高于任一单项检测,差异有统计学意义(P<0.05)。Kappa检验结果显示,串联检测、并联检测与金标准的一致性Kappa值分别为0.194、0.367(P<0.05);TB-DNA检测与金标准的一致性Kappa值为0.194(P<0.05)。结论:TB-DNA检测对血行播散型肺结核合并结核性脑膜炎具有较高的特异度,ADA、TB-DNA、TB-Ab联合检测有利于提高诊断效能,弥补单项检测的不足。Objective:To explore the diagnostic value of adenosine dehydrogenase (ADA),mycobacterium tuberculosis DNA (TB-DNA) and tuberculosis antibody (TB-Ab) in hematogenous pulmonary tuberculosis with tuberculous meningitis (TBM).Method:A total of 80 patients with hematogenous pulmonary tuberculosis treated in the Nanning Fourth People’s Hospital from January 2017 to December 2019 were selected,all of whom were suspected of complicating tuberculous meningitis.Cerebrospinal fluid was collected by lumbar puncture and ADA,TB-DNA and TB-Ab were detected.According to the results of clinical diagnosis as the gold standard,the diagnostic efficacy of ADA,TB-DNA,TB-Ab and combined detection were evaluated,and the consistency was analyzed.Result:In single test,the specificity of TB-DNA was 95.8%,which were higher than 62.5% and 45.8% of ADA and TB-Ab,respectively,the differences were statistically significant (P<0.05).But there was no significant difference in specificity of ADA and TB-Ab (P>0.05).The specificity of series test was 100%,which was higher than ADA and TB-Ab single test,the differences were statistically significant (P<0.05).The sensitivity of parallel detection was 91.2%,which was higher than that of any single detection,the differences were statistically significant (P<0.05).The results of Kappa test showed that the consistency Kappa values with gold standard of series detection,parallel detection were 0.194 and 0.367 respectively (P<0.05);the Kappa value of the consistency with gold standard of TB-DNA detection was 0.194 (P<0.05).Conclusion:The detection of TB-DNA has a high specificity for hematogenous pulmonary tuberculosis with tuberculous meningitis.The combined detection of ADA,TB-DNA and TB-Ab is helpful to improve the diagnostic efficiency and make up for the deficiency of single detection.

关 键 词：腺苷脱氢酶 结核分枝杆菌-DNA 结核抗体 血行播散型肺结核 结核性脑膜炎 

分 类 号：R521[医药卫生—内科学] R529.3[医药卫生—临床医学]